Publication: Efficacy of spiramycin as an alternative to amoxicillin in the treatment of acute upper respiratory tract infections
Issued Date
1998-07-08
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ISSN
11732563
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2-s2.0-0031836566
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Mahidol University
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SCOPUS
Bibliographic Citation
Clinical Drug Investigation. Vol.15, No.6 (1998), 461-466
Suggested Citation
Chaweewan Bunnag, Perapun Jareoncharsri, Siriporn Voraprayoon, Apichai Vitavasiri, Pornchulee Supatchaipisit, Supornchai Kongpatanakul Efficacy of spiramycin as an alternative to amoxicillin in the treatment of acute upper respiratory tract infections. Clinical Drug Investigation. Vol.15, No.6 (1998), 461-466. doi:10.2165/00044011-199815060-00001 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/18505
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Title
Efficacy of spiramycin as an alternative to amoxicillin in the treatment of acute upper respiratory tract infections
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Abstract
This study compared the efficacy of spiramycin with that of amoxicillin in treating patients with acute community-acquired upper respiratory tract infections (URTIs). The study was an open, randomised, comparative parallel design and patients received either spiramycin 3 MIU (2 tablets, 500 mg or 1.5 MIU per tablet) twice daily after meals, i.e. 6 MIU/day for 7 days or amoxicillin (500 mg/capsule) 1 capsule three times daily after meals, i.e. 1500 mg/day for 7 days. Patients attending the ENT outpatient clinic at Siriraj Hospital in Bangkok for treatment of acute URTIs were included in the study after giving their informed consent. Eligible patients comprised those aged 18 years and over, of either gender, who had at least two of the following symptoms: fever (≤ 38°C oral), nasal discharge/obstruction, sore throat, cough and/or hoarseness of voice that did not require parenteral drug therapy or hospitalisation. A total of 99 patients were included in this study, 49 patients received spiramycin and 50 received amoxicillin. Of the 45 assessed patients treated with spiramycin, 40 were judged by the investigators as a 'success' (89%), and five were judged a 'non-success' (11%), compared with 48 assessed patients in the amoxicillin group where 40 patients were classified as a 'success' (83.3%) and 8 were judged a 'non-success' (16.7%). No statistically significant differences between treatments were demonstrated regarding the overall efficacy of treatment. This study demonstrated that the prescribed regimens of spiramycin and amoxicillin were similarly effective in the treatment of adult acute URTIs. The tolerability of both drugs was also similar. Furthermore, it was noted that the convenient twice-daily dosage regimen of spiramycin may allow better patient compliance. According to the National Health Statistics of Thailand, in 1995 diseases of the respiratory tract were the most commonly recorded diseases in this country with a prevalence rate of 314.40 per 1000. In 1994, acute upper respiratory tract infection (URTI) was the second most common disease for inpatients, with a prevalence rate of 224.66 per 1000. These data reveal the significant impact of URTIs on the national health, and clearly the proper management of URTIs at an early stage may decrease the hospital admission rate of this disease. Amoxicillin has long been widely used as a first-line antibiotic in the treatment of URTIs, both in Thailand and internationally. However, the emergence of strains of microorganisms that have acquired resistance to penicillin antibiotics may be cause for some concern. Furthermore, the use of penicillin antibiotics has also been associated with adverse effects such as skin rashes. There is thus clearly a need for an alternative agent to amoxicillin when treating these infections. During recent years there has been an upsurge of interest from both clinicians and researchers in the use of macrolide antibiotics, particularly those with a 16-membered ring structure, for the treatment of respiratory tract infections. Spiramycin, a well-established macrolide, has such a structure and is also active against most common respiratory tract pathogens. It has been proven to have good penetration into respiratory tract tissues and fluids. Spiramycin has been used in the treatment of acute URTIs in Thailand for some years. In this study, we propose the use of spiramycin as an alternative to amoxicillin in treating patients with acute community-acquired URTIs by comparing their efficacy and tolerability in adult Thai patients.